Provider Demographics
NPI:1508814799
Name:METTA, KASEY LYNN (MA, ATC)
Entity Type:Individual
Prefix:MRS
First Name:KASEY
Middle Name:LYNN
Last Name:METTA
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 KIM CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6309
Mailing Address - Country:US
Mailing Address - Phone:732-557-4423
Mailing Address - Fax:
Practice Address - Street 1:COLONIA HS
Practice Address - Street 2:180 EAST ST
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067
Practice Address - Country:US
Practice Address - Phone:732-499-6533
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00116100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist